Why People Might Use Anxiety to Avoid Depression: What We Can Learn From a Wartime Experience

Michael W. Adamowicz, LICSW

Back in March of this year, I was listening to NPR while driving around town doing errands. Terry Gross was interviewing Donovan Campbell, the author of Joker One. His book is about a platoon of Marines stationed in Ramadi, Iraq. Campbell was talking to Gross about a soldier under his command that was killed in Iraq. Campbell began crying while talking about the death. I found it remarkable that a battle-hardened Marine officer who served three tours in the Middle East and had written a book on the topic could still allow himself the candor and authenticity to cry on national radio about a man who died several years earlier.

I bought the book. I was not disappointed.

Around the same time, I was puzzling over a clinical question that was happening frequently enough to catch my attention. In some cases, when treatment of anxiety symptoms was successful, depressive symptoms emerged. The reverse of that seemed also true: alleviation of depression sometimes led to resurging anxiety symptoms. I spent a lot of time thinking about the psychological and social conditions that might be at work in these instances.

Patients sadly asked me why it should be that now that the anxiety attacks were gone, instead of being happy they had become depressed. I had some stock answers to the problem. However, they no longer satisfied me. More importantly, I don't think my answers were helpful to them.

This process occurred both in individual and marital therapies. Anxiety symptoms apparently were defenses against becoming depressed. And if someone was previously anxious and then became depressed, the depression-in part-served as a defense against a return of anxiety.

Further, the symptoms themselves guarded against fully coming to terms with the reality of the person's or couple's situation. That all sounds complicated and I will attempt to unpack it as we go along.

Hope, I believe, also plays a pivotal role. Hope, that is, in both its manifestations: an alluring, sweetly promised desire and as an unfulfilled, tormenting, scoffing longing. But we'll get to that later.

In subsequent posts I will also provide clinical examples of anxiety as a defense against depression (and vice versa) for individuals and in marriages. I will also try to work out some of the dynamics involved.

But to get started, let's return to Donovan Campbell's Joker One. It was from reading this work that I began to formulate an answer to the clinical questions that were dogging me.

Some caveats before I begin. This is not a review of the book itself. Nor is this intended as an analysis of the book's author or the other marines. Nor am I making any comment on America's current wars or politics.

Rather, I simply want to look at some of the psychological effects of exposure to urban warfare.

I deeply respect and admire Mr. Campbell and the other Marines in this book. Nothing that I write below is intended as a slight or criticism of those men. I strongly recommend that you read Joker One. It is a work of art and love birthed in one of earth's many hells.

Okay, now to the book.

The setting is Ramadi, Iraq in 2004. In Campbell's words, the city "contained roughly 350,000 people...one of the highest population densities on earth...its alien nature struck me almost like a physical blow. No amount of training at abandoned U.S. bases could have prepared us..." Add to this that none of the 150 Marines spoke the local language. The city was home to unknown numbers of well-armed insurgents who did not wear identifying uniforms. Mortars were fired routinely into the Marine's base. Their job was to "walk the city on foot" where "trash and human waste littered every street" and for the 150 Marines to secure and stabilize the city of 350,000.

If that is not a recipe for anxiety or panic, then I have never heard one. Obviously, a platoon's commander cannot afford to have anxiety spread through the troops. Therefore, they would need good anxiety reduction strategies. I have written elsewhere on this topic and won't repeat my views here; a number of them would not apply to his battlefield conditions anyway. So, let's see how Campbell devises a real-time strategy for anxiety reduction and stress management in the midst of a hostile chaos and in the fog of war.

For one, he acts in the fashion of a true leader. Here's how he writes about it: "I had a responsibility to my men to provide for all their needs...Marines will only listen to those who have suffered alongside them, and if you want any credibility as a leader, you not only have to bear the same burdens as they, but you also have to try, to your utmost ability and every single day, to transfer those burdens from their shoulders onto yours."

He also instituted "a pre-battle ritual...that we only performed every time we left the base's confines..." The aim of this was to have "each of my Marines...think of himself first as a member of Joker One and only thereafter as an individual with needs and desires different from that of the team as a whole...a focus on the group and an overriding concern with the service and welfare of others." The ritual was a recitation of the Twenty-third Psalm.

So far, so good. Against an unknown, unseen force whose members were prepared to suicide if it would cause Marines to die, Campbell presents himself as a strong, competent and compassionate leader of a group of soldiers with a strong, common identity. Yet, within the recitation of the psalm was a paradox that ultimately threw Campbell into despair. But I am getting ahead of the story here.

There's much more to Campbell's campaign against anxiety and the dread of the unknown. But this is a good place to take a break. I will continue analyzing his strategy in the next post. In the meantime, may I again suggest that you pass the time by reading Joker One.